As a result of the failed Connector website, 160,000 Massachusetts residents are on temporary public Medicaid coverage even though they don’t qualify for MassHealth. Failure at the Connector will cost Massachusetts taxpayers over $100 million dollars this year. So, Pioneer has questions about how Massachusetts went from having a well-functioning Exchange to one of the worst performances of any state in the Union: 102 questions to be exact.

This week legislators on Beacon Hill are finally convening a second hearing in the seventh month since open enrollment started under the ACA, on the failures at the Connector.

This follows a recent Congressional hearing featuring the executive director of the Connector, and a February hearing in Boston where legislators simply vented at officials from the Commonwealth.

Yet, even with these two hearings, little information has been released to the public on how the state got into this mess in the first place.

In our ongoing efforts to improve transparency, serve as a watchdog for the public, and prevent a second failed website launch, Pioneer feels that these 100 questions need to be answered regarding just what happened during implementation. Can we have a real account of the budgetary impact of the failure? Just how will we ensure success in the future?

Please write to us if you have others to add to our growing list, or want to share your current experience with the Connector.

Implementation

Why did the Commonwealth decide to completely rebuild its website exchange? Why did it not work off the foundation of its old website?

Why did the University of Massachusetts Medical School hold the contract for the exchange development? Did the Connector and MA HHS shape the Early Innovator Grant application?

Why were the University of Massachusetts Medical School principal leads on the contract both policy experts, not technical experts?

What was the bidding process that led to the selection of CGI? What factors were considered?

What other companies bid on the contract?

What state employees provided technical expertise to design the website contract?

Were any of the website contracts granted on a sole-source basis?

Why did the state’s IT department (ITD) play a limited role in implementation and contracting?

It is clear to outside auditors that the original deal with CGI was too ambitious. Did state employees or CGI include the level of bells and whistles in the original contract?

(Background: The promise was a Rolls Royce exchange.)

10. Problems arose early with conversations about scaling back the original contract starting as early as January 2013, when did serious problems first start to emerge?

11. How quickly were issues escalated and to whom? What exactly was the escalation process?

12. When did senior staff at UMass Medical School first know about the problems?

13. When did Connector senior staff first know about the problems?

14. When did Mass HHS senior staff first know about the problems?

15. When did the Governor first know about the problems?

16. When did the CMS state officer assigned to Massachusetts know about the problems?

17. How frequently were these groups updated about the depth of the problems with the website?

18. Is there a precedent for reworking IT contracts multiple times in the Commonwealth during such a short engagement?

19. What are the guidelines for reworking state contracts? Were they followed?

20. Technical staff under contract with UMass Medical were removed from quality review committees because of their critical assessment of CGI’s work, why?

21. Independent reviewers criticized the Commonwealth for being understaffed in multiple areas of this project, and for high staff turnover, why was this the case?

22. Best practices for project management were not followed. Which were not, and how will things be different going forward?

23. Why was no firm pull the plug date set for the project?

24. When was the decision made to go live, even with the well-known lack of basic functionality?

25. What percentage of the website was expected to be functional on October 1st?

26. What percentage was functional on October 1st?

27. Why did the Connector spend significant advertising money in mid-October to increase traffic to the website with all of the known issues?

28. Why were the Governor and other senior Connector staff denying that the website had major problems until early November 2013?

29. Was it ever discussed to simplify MassHealth (Medicaid) eligibility rules during the design process?

(Background: Massachusetts has over 250 eligibility rules, and has added enormous complexity to the site design.)

30. Did state officials mislead the Federal government on the progress of the project at any point?

(Background: Independent reports have noted that code was often submitted with limited to no testing, and the Committee on Oversight has raised questions about security protocols being followed during the entire project.)

Were security agreements signed by state officials truthful for the level of security provided by the website to users?

(Background: As one example, a Minimum Acceptable Risk Standards for Exchanges agreement was signed by the executive director of the Connector and the HHS Secretary in September 2013. Yet independent auditors in September listed the lack of a testing schedule to determine the basic security of the system as a major concern. The Chairman of the U.S. House of Representatives Committee on Oversight has raised security concerns about the state connecting to the federal data hub.)

What was the standard of proof required by the federal government for the state to pass each “gate review” for the readiness of the site?

Why was the Commonwealth habitually slow in turning around the review of CGI code?

How many citizens have paid for their plan and still lack an insurance card?

(Background: At one point the number was over 2,200)

Why were there no basedlined deliverable and baseline dates updates as the project progressed? (Background: Independent auditors document a lack of baseline in August 2013, with the last being submitted in February.)

How many staff who worked on the UMass Medical School contract have been moved over to other departments or contractors still working on the project?

Why was CGI allowed to change delivery dates without consulting state officials? (Background: This has been a criticism by independent auditors.)

Why were changes to the project allowed “without formal approval and assessment of downstream impacts..”? (Background: This has been a criticism by independent auditors.)

Once the severity of the technical problems became overwhelming, why was contingency planning understaffed by both the Commonwealth and CGI? (Background: This has been a criticism by independent auditors.)

Why was the site allowed to go live without any UAT (user acceptance testing), a standard for any IT project?

When did CMS grant the Commonwealth a delay for testing under the CCIIO Blueprint Test Scenarios? (Background: Independent auditors have noted the state missed the 8/23/2014 delayed deadline.)

Why was there no “formal method for holding individuals and organizations accountable for achieving agreed-to deadlines for project tasks”? (Background: This has been a criticism by independent auditors.)

Why was it announced to the public that CGI was being “fired” before the state had developed the terms of that separation?

Budget Related44. What is the estimated state cost for the roughly 159,000 individuals placed on the MassHealth (Medicaid) program temporarily by the different kinds of populations? For example, AWSS (aliens with special status) in addition to other populations like newly eligible making over 300%-400%FPL, etc?(Background: Currently a 50/50 split with the Feds, but this is far worse for the state than if individuals were receiving a premium tax credit under the Affordable Care Act. An incomplete early answer has been floated around $10 million a money just for the AWSS population.)45. What percentage are expected to be premium paying members once their paperwork is processed?

46. What is the difference in additional state costs versus federal costs if the website worked?

47. What is the timeline for moving these individuals off the temporary Medicaid coverage?

48. Will screening be done in batches?

49. Will screening be done by eligibility categories?

50. Why was there no contingency plan designed for moving these individuals off Medicaid when the contingency planning for the website was formulated in the summer of 2013?

51. When will the state know how much money they have spent on free or heavily subsidized coverage for those that don’t qualify for a full federal subsidy or Medicaid?

52. Will the Federal government retroactively reimburse the state for any additional costs that has been incurred to cover these individuals over and above what it would have cost if the state had a functional website?

53. How many citizens have signed up for Medicaid that were previously eligible, but not enrolled under the ACA?

54. How much of the $180 million that was given to the state of Massachusetts for exchange activity is left?

55. What was the breakdown of how the $180 million was spent?

56. What is the monthly cost of the “workarounds” the Connector is currently employing? And what pot of money is this being drawn from? (Background: Optum is being paid $16m for the first 45-60 days of work.)

57. What other contractors are working on workarounds or fixing the site outside of Optum, and what is the cost?

58. CMS paid for an independent MITRE report, where was that money drawn from? And how much did it cost?

59. Massachusetts has requested an additional $50 Million from the federal government, what will this money be spent on?

60. How much additional federal money, outside of the $50 million request, has been committed to the review and ongoing maintenance efforts of the Connector?

61. When will there be a projected cost for the website?

62. How many refunds were granted for individuals that left the Connector out of frustration to buy insurance on their own on the market?

63. How will/are claims for these citizens being handled? Who will pay for them, the state, the insurer, the federal government, the state’s uncompensated care pool? State or federal taxpayers?

64. How many individuals have paid first month of premium?

65. How many have paid second month of premium?

66. How many have received letters saying they have not paid their premiums, but their checks have been cashed?

67. With UMass Medical School still in control of millions of dollars on the contract, but no longer working on the project, who will decide how the remaining money is spent?

68. Will CGI have future legal claims against the State for underpayment?

69. Since the Connector will not hit its 200,000-250,000 covered lives goal by March, 31, 2014, what will the budgetary consequences be for the Connector?

70. Will the Commonwealth need to pay CGI for the code they have developed?

71. What future Connector and other state activities will be curbed as a result of the extra spending to fix the website?

Moving Ahead72. Under what legal rationale was CMS able to allow for transitional Medicaid coverage for 159,000 residents in the Commonwealth?73. Will the 3 R’s risk adjustment programs apply for this temporary Medicaid coverage?

74. What percentage of the original project has CGI, and other contractors, delivered as of today?

75. What percentage of the delivered work functions currently?

76. What remains to be built? Put another way, what percentage of the work flows have been finished on the project?

77. What remaining integration issues still remain for the “finished” work flows?

78. CGI was supposed to deliver a delayed but more functional website “Release 1.1″ in mid-Dec 2013, what is the current timetable for this release?

79. Will there be coordination of care issues with networks or doctors that are covered under the temporary MassHealth program, but not under Connector coverage?

81. Why has it taken so long to decide on a path forward to fix the site?

(Background: Other states are months ahead of the Commonwealth.)

82. Will the state be seeking any additional waivers from the Federal government related to the exchange?

83. What originally planned functions of the website will be dropped going forward?

84. Will CGI be banned from working on future updates of their code?

85. Executive directors in Hawaii, Oregon, Minnesota, Maryland, and Nevada– and both state and federal chief information officers have resigned over failed launches of exchanges, should we expect similar levels of accountability in the future in Massachusetts?

86. Independent auditors routinely noted the state lacked financial management personal to manage this project. What is being done to address this concern?

87. When will the state hold an open and transparent vetting of the procurement and technology issues under the IT development process?

88. Many states with struggling exchanges have set up bi-partisan oversight committees to monitor developments going forward, legislative and state auditors have commenced comprehensive reviews of the programs, and regular hearings are being held? What are state officials committing to going forward?

89. An independent MITRE report makes it clear that some previous work lacked a baselined set of requirements, when will these be set?

90. Have any technical fixes, not just workarounds, been started on the Connector code?

91. Individuals under the ACA must be able to report life changes such as a marriage, divorce, birth, a job promotion or raise etc, as they directly impact the level of advanced premium tax credit payment. If underreported, these changes will result in a “clawback” payment to the IRS in April of 2015. Does the Connector allow for such changes now?

92. If no, will the state be liable for any additional cost associated with the inability for those individuals to report such changes?

93. Most SHOP functions were delayed, is there a design plan for moving forward?

94. When can we expect to see these plans?

95. What mitigation strategies are being planned if the planned “fixes” do not happen on schedule?

96. What are the pros and cons of the state defaulting to the federal exchange?

97. Has the state explored purchasing software from other states with functional state-exchanges? Which ones?

98. Has the state explored purchasing software from private vendors? Which ones?

99. Will the Connector be self-sustaining next year?

100. If not, will the Federal government let them use establishment funds in 2015?

101. If not, what contingency plans are being discussed to fund the Connector? Tax/fee increase on small business insurance plans, state budget funds?)

102. How could the procurement process prevent this sort of situation again in the Commonwealth? Especially if the state hires another contractor moving forward.

About the Author

Josh Archambault is Pioneer’s Director of the Center for Healthcare Solutions. He is editor and co-author of The Great Experiment: The States, The Feds, and Your Health Care. Prior to joining Pioneer, Archambault was selected as a Health Policy Fellow at the Heritage Foundation in Washington, D.C. He has served as legislative director in the Massachusetts State Senate Scott Brown and as senior legislative aide in the Governor’s Office of Legislative and Intergovernmental Affairs. He holds a master’s degree in public policy from Harvard University’s Kennedy School and BA degrees in political studies and economics from Gordon College.
Josh has been interviewed on radio and news outlets around the country. His work has been featured in a range of publications, from The Wall Street Journal, Chicago Tribune, The Boston Globe, Politico, The Cleveland Plain Dealer, Milwaukee Journal Sentinel, and The Anchorage Daily News. Josh regularly speaks on state and national health care issues, and urban redevelopment and performance management.

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privateparty

No comments/answers posted here yet? Odd, since some of the answers are public record (see, for instance, the Connector’s website for minutes of the board meeting at which the selection of CGI was approved).

Josh Archambault

PrivateParty Feel free to post any answers you find. We have found out answers to about a dozen or so through meetings and media reports since this was posted. However, the Board never selected CGI, UMass Medical School did.